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Introduction Delirium in critically ill adults is associated with prolonged hospital stay, increased mortality and greater cognitive and functional decline. Current practice guideline recommendations advocate the use of non-pharmacological strategies to reduce delirium. The routine use of scheduled haloperidol to treat delirium is not recommended given a lack of evidence regarding its ability to resolve delirium nor improve relevant short-term and longer-term outcomes. This study aims to evaluate the efficacy and safety of haloperidol for the treatment of delirium in adult critically ill patients to reduce days spent with coma or delirium.Methods and analysis EuRIDICE is a prospective, multi-centre, randomised, double-blind, placebo-controlled trial. Study population consists of adult intensive care unit (ICU) patients without acute neurological injury who have delirium based on a positive Intensive Care Delirium Screening Checklist (ICDSC) or Confusion Assessment Method for the ICU (CAM-ICU) assessment. Intervention is intravenous haloperidol 2.5 mg (or matching placebo) every 8 hours, titrated daily based on ICDSC or CAM-ICU positivity to a maximum of 5 mg every 8 hours, until delirium resolution or ICU discharge. Main study endpoint is delirium and coma-free days (DCFD) up to 14 days after randomisation. Secondary endpoints include (1) 28-day and 1-year mortality, (2) cognitive and functional performance at 3 and 12 months, (3) patient and family delirium and ICU experience, (4) psychological sequelae during and after ICU stay, (4) safety concerns associated with haloperidol use and (5) cost-effectiveness. Differences in DCFDs between haloperidol and placebo group will be analysed using Poisson regression analysis. Study recruitment started in February 2018 and continues.Ethics and dissemination The study has been approved by the Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam (MEC2017-511) and by the Institutional Review Boards of the participating sites. Its results will be disseminated via peer-reviewed publication and conference presentations.Trial registration NCT03628391

Objetive: Self-expandable plastic stents (SEPS) are increasingly being used for treatment of postoperative esophageal leak. This complication occurs in 4-27% of patients after radical gastrectomy, and has a high mortality rate up to 60%. The aim of this study is to evaluate the efficacy of SEPS (Polyflex®) for treatment of post-operative eshopago-jejuno anastomosis leak after radical gastrectomy for gastric cancer. Material and methods: During one year period patients who underwent a radical gastrectomy in our hospital for gastric cancer and developed a postoperative anastomotic leak were prospectively included in the study after signing a consent form, and treated with SEPS placement under endoscopic and fluoroscopic control for leak occlusion. Results: Four patients were included (3 men/1 woman). The mean interval between operation and SEPS placement was 16 days (range: 4-34). SEPS deployment was easily performed in all patients with complete occlusion of esophageal lumen in three patients. In the fourth patient we needed to deploy a second coaxial stent to achieve a complete occlusion of the fistula. SEPS migration did not happen in our series. One patient had already developed a mediastinitis by the time we placed the SEPS and he died 3 days later. Extraction of the SEPS was easily performed 4-8 weeks after deployment. Conclusion: We achieved a complete healing of the anastomotic fistula after radical gastrectomy in 3 out of 4 patients, without major complications related to SEPS. Placement of SEPS is an appealing minimally invasive alternative to surgical repair for patients with postoperative anastomotic leak.

The Washington National Primate Research Center (WaNPRC) maintains the largest domestic breeding colony of pigtail macaques (Macaca nemestrina) in the United States, with animals housed in small to medium-sized social groups. As part of the animal care plan, a programmatic framework is utilized, which integrates clinical care with socialization considerations for nonhuman primates (NHPs). This framework encompasses the following areas: (1) socialization in the clinical setting; (2) positive reinforcement training (PRT); (3) measures to ensure proper identification and medication distribution; and (4) in-group treatments. The success of this framework is demonstrated by the high socialization rate for hospitalized animals (99.5% social pairing success), with the majority of clinical cases (95%) being treated in social groups. Ultimately, this framework seeks to buffer stressors when animals require clinical care or husbandry manipulations. Taken together, the above components foster an environment that provides a comprehensive approach to NHP medical and behavioral management.

Obesity is the main challenge for public health systems. Functional foods have emerged as an alternative to the ineffectiveness of pharmacological therapies. However, it is necessary to investigate to find sources of raw material for its preparation. The aim of this work was to evaluate the functional effects of residual avocado seed in diet-induced obese mice. Animals were fed a high-fat diet supplemented with avocado seed (1.25%) for 6 weeks. Body weight, food intake, satiety, physical activity, and energy expenditure-involved gene expression were measured. Supplementation with avocado seed led to reduced body weight, delayed satiety, increased physical activity, and induced Dio2 and Adrb1 expression in hypothalamus and white adipose tissue, respectively. No changes in markers of hepatic injury were observed. In conclusion, avocado seed exerts functional effects on obese mice, by promoting energy expenditure, without toxicity effects, making it possible to use this by-product in the development of functional foods.

El objetivo general de este estudio fue evaluar y discutir el papel mediador del liderazgo transformacional entre la asociación de resiliencia y la intención empresarial, en adultos peruanos. En esta investigación participaron 199 adultos, 96 (48%) mujeres y 103 (52%) hombres, de edades entre los 18 y 50 años (M = 24, DE = 6.94). Se evaluaron sus propiedades psicométricas de los instrumentos, obteniendo valores apropiados correspondiente a la evidencia de validez basado en la estructura interna (mediante AFC) y confiabilidad (mediante el método de consistencia interna, coeficiente alfa y omega). El nivel de Liderazgo Transformacional se evaluó con el cuestionario multifactorial MLQ-5X, la resiliencia se evaluó con la escala de Resiliencia de Connor-Davidson y, por último, la intención empresarial fue evaluado mediante el Cuestionario de Intención Empresarial. Los resultados corroboran que a partir de la estimación del efecto mediador del Liderazgo Transformacional entre la resiliencia y la intención empresarial los resultados obtenidos representó 71.1% de mediación. El efecto directo entre resiliencia sobre la intención empresarial no fue estadísticamente significativo (p = .169, 28.9%). En conclusión, el liderazgo transformacional cumple el rol mediador de tipo completa, como principal incidencia sobre la variable intención empresarial. Por último, hay evidencia de una fuerza predominante del liderazgo transformacional como variable mediadora.

Metareasoning suffers from the heterogeneity problem, in which different researchers build diverse metareasoning models for intelligent systems with comparable functionality but differing contexts, ambiguous terminology, and occasionally contradicting features and descriptions. This article presents an ontology-driven knowledge representation for metareasoning in intelligent systems. The proposed ontology, called IM-Onto, provides a visual means of sharing a common understanding of the structure and relationships between terms and concepts. A rigorous research method was followed to ensure that the two main requirements of the ontology (integrity based on relevant knowledge and acceptance by researchers and practitioners) were met. The high accuracy rate indicates that most of the knowledge elements in the ontology are useful information for the integration of multiple types of metareasoning problems in intelligent systems.

This is a consensual multi-dyadic exploration of the diverse perspectives of seven community subgroups’ perceptions of events before, during, and after the 2014 police-involved shooting death of Michael Brown, Jr. in Ferguson, Missouri. Recognizing an enacted environment in the complex history that preceded the uprising, findings were contextualized and framed through the cosmology episode trauma model. A multicultural and visibly diverse research team conducted 34 interviews with involved citizens (protesters), law enforcement, clergy, politicians, business owners, media personnel, and educators. A culturally diverse cross-analysis team triangulated social perspective through consensus coding and audit. Consensual multi-dyadic method preserved the unique characteristics of each subgroup’s phenomenology, to ensure culturally sensitive and decolonized research methods, enabling an in depth look at the factors necessary for conciliation. Insight into motivational factors, narrative meaning-making, and implications for intervention and treatment are discussed.

While there is a tremendous literature documenting the positive value of religious and spiritual (R/S) constructs on an array of psychosocial outcomes (e.g., health, resilience, coping ability), Spiritual Crisis (SC) reflects the negative side of the numinous in a way that stresses the value and importance of R/S constructs for psychological functioning. This study examined whether numinous constructs are more relevant to theists or represent universal psychological qualities. Using an MTurk-based sample comprising both theists and atheists (N = 1399; 800 women and 595 men, four gave no response), the predictive ability of SC on both affective and characterological distress was examined using both regression and SEM analyses. The results indicated that both theists and atheists understood the numinous in similar ways and that scores on SC were of equal incremental predictiveness for both groups. SEM analyses supported the causal model that understood SC to be a unique and independent (from the personality domains of the Five-Factor Model) predictor of these clinical outcomes. These findings stress the value of the numinous for understanding all clients and that psychological assessment needs to systematically address numinous constructs in order to ensure comprehensive treatment of psychological impairment.